选择性5-羟色胺再摄取抑制剂安全性研究概述

选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors，SSRIs）是广泛应用的新型抗抑郁药，用于治疗各种抑郁症。常用的SSRIs有氟西汀、帕罗西汀、舍曲林、氟伏沙明及西酞普兰。SSRIs有多种类型的不良反应，主要为胃肠道反应、停药反应、性功能障碍及抗利尿激素异常分泌综合征等。SSRIs有可能增加儿童和青少年自杀意念和行为的风险，但目前尚无定论。最新研究表明，孕妇早期服用SSRIs似乎不增加胎儿先天畸形风险，但孕妇晚期服用SSRIs，可致新生儿出现肺动脉高压和停药综合征。一般而言，用含SSRIs的母乳喂养是安全的，因其在乳汁中的含量很低，但长期服用对婴儿发育的影响尚不清楚。对于老年人，SSRIs可增加骨折风险。SSRIs和某些药物联用发生相互作用导致的不良反应如下：单胺氧化酶抑制剂：5-羟色胺综合征；利尿剂：严重低钠血症；抗凝血药：增加出血危险；非甾体抗炎药：增加上消化道出血风险；色氨酸：5-羟色胺综征；阿司咪唑、特非那定：室性心律失常，Q-T间期延长；氟哌啶醇、马普替林：严重锥体外系反应；锂盐：锂血浓度升高，毒性增加。总之，SSRIs的不良反应虽然少于三环类抗抑郁药，但其有自身特有的不良反应。因此，医师临床使用SSRIs应予以注意。

Overview of researches on safety of selective serotionin reuptake inhibitors

Selective serotouin reuptake iuhibitors （SSRIs） are a widely used newer class of antidepressants, which can treat different types of depression. The commonly used SSRIs are fluoxatine, paroxetine, sertraline, fluvoxamine, and citalopram. The SSRIs can cause various types of adverse reactions. The main adverse reactions are gastrointestinal disorders, withdrawal reactions, sexual disturbances, and syndrome of inappropriate secretion of antidiuretic hormone （SIADH）, etc. SSRIs may increase the risk of suicidal thinking and behaviour in children and adolescents, but the issue remained controversial. Tile recent studies have suggested that exposure to SSRIs early in pregnancy appeared to be no increase in the risk of congenital malformations ; however, exposure to SSRIs late in pregnancy may incresae the risk of pulmonary hypertension and withdrawal reactions of the newborn. In general, breast-feeding with SSRIs is regarded as safe because the amount of drug is very low in breast milk. But the possibility of long-term effects on development in the infant is unknown. As for the elderly, SSRIs may increase the risk of fracture. Adverse reactions resulting from interations of SSRIs with some drugs are given below. MAOIs： serotonin syndrome; diuretics ： severe hyponatremia; anticoagulants： increased risk of bleeding; NSAIDs： increased risk of upper gastrointestinal bleeding; tryptophan： serotonin syndrome; astemizole, terfenadine： ventricular arrhythmias and Q-T interval prolongation; haloperidol, maprotiline： severe extrapyramidal symptoms; lithium increase in plasma lithium concentration and lithium toxicity. Overall, SSRIs have fewer adverse effects than tricyclic antidepressants, but the SSRIs do have characteristic adverse reactions of their own. Therefore, doctors should exercise caution when prescribing SSRIs to patients in clinical practice.